USMLE-Rx - Medicine

Question 1

When should you prescribe a statin in the patient with DM?

Answer 1

In patients with diabetes aged 40-75 or age >30 with 15+ years of DM, or if they meet lipid-lowering criteria

Question 2

What is Conn syndrome? What is the typical presentation?

Answer 2

Primary hyperaldosteronism, typically caused by an adrenal tumor. Presents as refractory hypertension and hypoK+

Question 3

What is the diagnosis in this 56yo who presents with pancytopenia, fatigue, easy bruising, night sweats and splenomegaly? What is the 1st line therapy?

Answer 3

Hairy cell leukemia. Cladribine or pentostatin are 1st line (adenosine deaminase purine metabolism inhibitors).

Question 4

What does purified protein derivative testing test for

Answer 4

Tb

Question 5

What is the explanation for pulsus paradoxus blood pressure variability

Answer 5

The pathoogy of pulsus paradoxus is that inspiration increases RV filling which compresses the LV and reduces stroke volume

Question 6

What are the most common sites of extrapulmonary involvment of coccidioidomycosis?

Answer 6

Skin and CNS

Question 7

What does CREST syndrome stand for?

Answer 7

Calcinosis
Raynaud's
Esophageal dysmotility
Scleroderma
Telangiectasia

Question 8

What antibody is elevated in CREST syndrome? What about diffuse scleroderma?

Answer 8

CREST - Anticentromere antibody or antinucleolar antibody

Diffuse scleroderma - Anti-Scl-70 (anti-DNA topoisomerase I)

Question 9

What antibody is elevated in SLE?

Answer 9

Anti-Smith and anti-SSA (the latter also in Sjogrens)

Question 10

What type of antibody is elevated in primary sclerosing cholangitis or small-vessel vasculitis?

Answer 10

ANCA (antineutrophil cytoplasmic antibody)

Question 11

What kidney drugs cause hypokaliémie? Hyperkalemia?

Answer 11

Hypokaliémie can be caused by loop diuretics or thiazide diuretics

Question 12

What type of pathology is associated with an S4 and a crescendo decrescendo systolic murmur that worsens with valsalva?

Answer 12

HOCM - abnormal mitral valve.

Question 13

Which arrhythmia is most commonly found in the setting of HOCM? Which arrhythmias lead to sudden death?

Answer 13

A fib. Vtach and V fib cause sudden deaths.

Question 14

How do you distinguish between post-strep glomerulonephritis and IGA néphropathie?

Answer 14

Timing: iga can be concurrent or shortly after illness whereas post strep is weeks later
Complement: C3 is low in post strep

Question 15

What does Medicare part A cover

Answer 15

Hospital care, hospice, nursing home or home health care.

Question 16

What does medicare part B cover?

Answer 16

Outpatient services, preventative care, clinical research, ambulance, medical equipment

Question 17

What is medicare plan C cover?

Answer 17

C is for private coverage / medicare advantage programs

Question 18

What treatment (in addition to blood pressure control) can slow the disease progression of ADPCKD

Answer 18

The most effective measure to slow disease progression in young patients with ADPCKD is tolvaptan, an ADH V2R receptor blocker.

Question 19

What do you give for prophylactic of someone who has calcium oxalate stones?

Answer 19

Thiazide diuretic (reduces ca2 in urine by increasing calcium resorption)

Question 20

What type of crystals are found in the setting of gout?

Answer 20

Urate crystals

Question 21

When you see suspect a gastrinoma and angiofibromas, what blood test should you order?

Answer 21

This is MEN1 - think hypercalcemia from parathyroid adenomas

Question 22

What is the window to administer tPA for stroke?

Answer 22

Less than or equal to 4.5hrs since last known well

Question 23

Are PPD tests reliable for TB diagnosis in individuals who are HIV +ve?

Answer 23

No, not below 500 CD4

Question 24

Tumor lysis syndrome: what is the constellation of metabolic disturbances)

Answer 24

hypoCa2+
hyper PO4
hyper K+
hyperuricemia

Question 25

what is the treatment of tumorr lysis syndrome?

Answer 25

Phosphate binder, calcium gluconate;
Hydration, Allopurinol, Rasburicase;
Kayexalate, insulin + glucose to shift
bicarb

If refractory, then dialysis

Question 26

Isolated high ALP in a patient with hearing loss and bone pain is suspicious for what disease?

Answer 26

Paget disease (bone remodeling problem)

Question 27

How do you distinguish between eosinophilia granulomatosis with polyangiitis and GPA?

Answer 27

EGPA is P-ANCA; also has asthma

Question 28

What type of IBD is characterized by skip lesions?

Answer 28

Crohn’s

Question 29

What ibd is associated with primary sclerosis cholangitis

Answer 29

Ulcerative colitis

Question 30

What disease process would produced enlarged kidneys, HTN, and berry aneurysm?

Answer 30

ADPCKD